Clinical Data Supporting Antiviral Treatment of Meniere’s Disease

The majority of both general practitioners and otolaryngologists contend, just as they learned in medical school, that Meniere’s Disease is “idiopathic,” without any known or discoverable cause.

That’s an out-of-date, no longer valid way of viewing the Meniere’s treatment problem.

With that older perspective, the majority of American physicians must resort to the textbook “treatment” of putting the patient on a low-dose dietary salt regimen, along with a prescribed diuretic, a “water pill.” Even though the physician will claim that the cause of Meniere’s is idiopathic, he will still presume, in the absence of any other useful information, that the real cause of Meniere’s symptoms is too much salt in the diet, which causes the accumulation of fluids in the inner ear. Minimizing dietary salt is to help reduce the inner ear fluid build-up (the hydrops condition), and the diuretic is to cause the body to urinate away enough water so as to help dry out the inner’s excess water.

For many, perhaps even most, this initial Meniere’s treatment has good results — at least for a period. But for many others, perhaps a majority, it brings only temporary or no results. The symptoms of Meniere’s disease continue to amplify and debilitate the patient. The unfortunate medical pronouncement by most physicians facing a patient who hasn’t positively responded to the low salt/diuretic approach is, “Learn to live with it. There’s nothing more we can do.”

In the last century, such was the conundrum of Meniere’s treatment in the US. Some severe inner ear surgeries (slicing of the vestibular nerve between the brain and ear, or surgical extraction of the labyrinth, a labryinthectomy) were the only “final solutions” — ones with frequent concomitant difficulties, such as profound deafness, etc. Then, the disease often re-appeared in the untreated contralateral ear, where surgical interventions would have to be taken again.

But fortunately, in the last decade or more, researchers in Europe particularly, and a few here in the US, have clinically proven that the root cause of the vast majority of Meniere’s cases is a herpes virus infection in the inner ear itself, or in adjacent nerves. Abundant clinical experience and histological and clinical studies now prove that inner ear herpes infections can be controlled and suppressed with appropriate drugs, bringing substantial or complete symptomatic relief.

But most physicians are ignorant of such information, unfortunately. Consequently, described below is information that should be presented (properly and effectively) to physicians treating cases of Meniere’s. If you have Meniere’s (or vestibular neuritis, or BPPV), expend the effort to get the useful information below to your physician.

For understandable reasons, most physicians a) do not believe a herpes virus causes Meniere’s (they weren’t taught that in med school, and no one has told them otherwise since), and b) once they learn of and believe herpes virus’s root cause of Meniere’s symptoms, they have no reliable information on how to prescribe modern antiherpetic drugs to treat this formerly-untreatable disease. The information below will help a Meniere’s patient get the useful info to his or her physician, so the effective antiherptic (herpes-drug) therapy can be prescribed.

BEFORE you have an appointment with your doctor, drop off the printed article to your doctor’s office, deliberately and specifically asking the nurse or office attendant to make sure the good doctor gets to read the article several days before your appointment.

On the first page of the print-out, make a note to the doctor, asking him to specifically read the Clinical Series section starting on page 103, noting the drugs to prescribe, dosages, durations, etc. The following would be a suggested text, either on the document itself, or a clipped-on separate note or print-out:

Dr X,

I respectfully ask you to scrutinize the information in this recent journal article. The author, Dr. Richard Gracek of Boston, is extremely experienced in antiherpetic therapy of Meniere’s, as the article will reveal.

Read closely the information on P. 103, for effective dosages and durations. Dr. Gracek gains an 88% to 90% complete relief of Meniere’s symptoms with his protocols, described in the paper.

My thanks.

That’s it. If the good physician chooses to neglect or reject your provided medical information, it’s time to find a more open-minded doctor who will treat with evidence-based approaches.

For your information — and for the physician’s — here’s the cogent treatment text. I’ve taken the liberty to highlight crucial information:

The antiviral treatment protocol for patients with recurrent vertigo is as indicated below.

Discontinue all previous medical treatments; ensure that patients are cleared for normal
renal and liver function; use acyclovir tabs 800 mg t.i.d. for 3 weeks and reexamine. If thereis significant relief of vertigo, decrease to 800 mg b.i.d. for 3 weeks, then to 800 mg daily as amaintenance dose. If valacyclovir is selected (in those who fail to respond to acyclovir), use1 g t.i.d. for 3 weeks with taper to b.i.d. for a further 3 weeks and then 1 g daily as a maintenancedose. The starting dose of acyclovir was given for a longer period (3 weeks) than thatused for zoster because it was felt necessary to cross the blood-brain barrier to reach ganglionand satellite cells with virus. Most patients experienced relief from vertigo in the first 2 weeks
but some required a longer period. The gradual lowering dose was then used to find the
lowest level maintenance dose for a given patient. Most were controlled on a single dose daily
but occasionally a patient required an adjustment to 1,200 mg of acyclovir or 1,500 mg of
valacyclovir.
These dosages may require adjustment in patients with impaired kidney or liver function.
The follow-up period was as short as 3 years in the most recent patients and 8 years in the
earliest patients in the series. Of 106 patients with VN (the earliest patients evaluated up to
8 years), 93 (88%) had complete relief of symptoms with oral acyclovir, 54 of 60 patients(90%) with MD [Meniere's disease] were relieved of vertigo, and 27 of 45 patients (60%) with posterior canal
BPPV were relieved of symptoms. Between the use of antivirals and repositioning maneuvers
(physical therapy), the number of chronically disabled patients who were candidates for
ablation of posterior semicircular canal function (canal occlusion or singular neurectomy)
was reduced significantly.
As a result of these morphological and clinical observations, our approach to the patient
with recurrent vertigo has been simplified. It goes without saying that the patient without
recurrent balance symptoms needs no further treatment after a hearing test and MRI of the
brain (assuming that these are normal). A Hallpike maneuver is included in the initial examination.
Those patients with recurrent vertigo are offered a trial of oral acyclovir (or Valtrex)
for 3 weeks.
Examination at the 3-week period will determine the sensitivity of the particular NT
virus to the antiviral. If there is no relief of vertigo with acyclovir or valacyclovir, treatment
is followed by vestibular tests (videonystagmography and vestibular-evoked myogenic
potential) to determine the responsible ear. If these results are abnormal chemical labyrinthotomy
is offered. The patient is offered a choice between dexamethasone (12 mg/ml) or
gentamycin (80 mg/2 ml), considering the risk of hearing loss (dexamethasone 0%; gentamycin
usually negligible if used in a single small dose).

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